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Segmental quantitative myocardial perfusion with PET for the detection of significant coronary artery disease in patients with stable angina

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The goal of this study is to determine the technical accuracy of segmental perfusion parameters assessed with quantitative cardiac PET imaging in the evaluation of coronary artery disease (CAD) in patients with stable angina.

Methods

A cohort of patients who participated in the EVINCI protocol underwent an evaluation of coronary anatomy by invasive coronary angiography (ICA) and/or coronary computed tomography angiography (CCTA) and PET myocardial perfusion imaging with H2 15O, 13NH3 or 82Rb. PET studies were analyzed by two independent observers blinded to clinical and instrumental data, and classified as positive or negative for significant CAD using only segmental perfusion measurements and cut-off values from literature.

Results

On a per-patient basis, the overall inter-observer agreement on PET results was 90 % (kappa = 0.79), indicating substantial agreement. On a per-vessel basis, the inter-observer agreement on PET results was 88 % (kappa = 0.74) in the RCA territory, 94 % (kappa = 0.84) in the LAD territory and 94 % (kappa = 0.85) in the LCX territory.

Segmental PET measurements correctly identified 85 % of the patients, resulting in a global sensitivity of 86 %, a specificity of 84 %, a positive predictive value (PPV) of 69 % and a negative predictive value (NPV) of 93 %.

In vessel-based analyses, quantitative perfusion parameters had a sensitivity, specificity, PPV and NPV of 92 %, 82 %, 42 % and 99 %, respectively, for the detection of significant coronary stenoses in all major coronary arteries.

Conclusions

The assessment of absolute myocardial perfusion parameters measured at a segment level lead to reliable and accurate identification of patients with significant coronary stenosis at ICA and/or CCTA.

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Authors and Affiliations

  1. Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Nuclear Medicine Unit, University of Florence, Largo Brambilla 3, 50134, Florence, FI, Italy

    Valentina Berti, Roberto Sciagrà & Alberto Pupi

  2. Institute of Clinical Physiology, CNR, Pisa, Italy

    Danilo Neglia

  3. Heart Center and Turku PET Center University of Turku and Turku University Hospital, Turku, Finland

    Mikko Pietilä & Juhani Knuuti

  4. Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

    Arthur J. Scholte

  5. Nuklearmedizinische Klinik, Technische University of Munich, Munich, Germany

    Stephan Nekolla

  6. Department of Nuclear Medicine, Bichat University Hospital, University Paris Diderot, Paris, France

    François Rouzet

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  1. Valentina Berti
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Correspondence to Valentina Berti.

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Information on grants and other forms of financial support

This work was supported by a grant from the European Union FP7- CP-FP506 2007 (grant agreement no. 222915, EVINCI [Evaluation of Integrated Cardiac Imaging for the Detection and Characterization of Ischemic Heart Disease]). It was also supported in part by the Centre of Excellence in Molecular Imaging in Cardiovascular and Metabolic Research, the Academy of Finland, the Cardiovascular Biomedical Research Unit of the Royal Brompton & Harefield National Health Service Foundation Trust, the National Institute for Health Research Cardiovascular Biomedical Research Unit at St Bartholomew’s Hospital, the Ministry of Science and Higher Education, Poland and unrestricted grants and products from General Electric Healthcare. This work forms part of the research themes contributing to the translational research portfolio of the NIHR Cardiovascular Biomedical Research Unit at Barts, which is supported and funded by the National Institute for Health Research.

All authors had no relationship with industry and financial associations from within the past 2 years that might pose a conflict of interest in connection with the submitted article.

All procedures have been approved by the appropriate institutional and/or national research ethics committee and have been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Berti, V., Sciagrà, R., Neglia, D. et al. Segmental quantitative myocardial perfusion with PET for the detection of significant coronary artery disease in patients with stable angina. Eur J Nucl Med Mol Imaging 43, 1522–1529 (2016). https://doi.org/10.1007/s00259-016-3362-0

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  • DOI: https://doi.org/10.1007/s00259-016-3362-0

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